Coverage and factors associated with receipt of early newborn postnatal care components in Afghanistan: findings from the 2022-2023 multiple indicator cluster survey.

内容摘要

Neonatal mortality remains high in low‑ and middle‑income countries, where early postnatal care (PNC) within 48 hours can avert many deaths. Yet neither the national coverage of newborn PNC nor the factors associated with its receipt have been assessed. We assessed the coverage of newborn PNC components and the factors associated with their receipt in Afghanistan. We conducted a cross‑sectional analysis of 11,965 mother-infant dyads from the 2022-2023 Afghanistan Multiple Indicator Cluster Survey. The outcome was coded 'yes' if the infant received at least two of the following six newborn PNC components within 2 days of birth: temperature measurement, weighing, cord examination, breastfeeding counseling, observation of breastfeeding, and counseling on danger signs. We fitted a multivariable logistic regression model to identify factors associated with the outcome. Only 41.0% of infants received ≥2 components; merely 1.9% received all six components of PNC. The odds of receiving ≥2 components of PNC were higher among infants whose households had an educated head, whose mothers attended 1-3 or ≥4 antenatal care (ANC) visits, those born in private and public health facilities, and those delivered by cesarean section. Infants in higher wealth quintiles also had progressively greater odds. Conversely, infants perceived as small at birth had lower odds of receiving ≥2 PNC components. Four out of ten newborns received ≥2 components of PNC, with marked inequities by head of household education, ANC use, delivery setting, and wealth status. Targeted interventions addressing these inequalities are urgently needed to strengthen early newborn PNC. Main findings: Four out of ten newborns in Afghanistan received at least two components of early postnatal care, with substantial inequalities by head of household education, antenatal care use, place of birth, birth size, and household wealth.Added knowledge: This study provides nationally representative evidence on the receipt and associated factors of early newborn postnatal care in Afghanistan, moving beyond previous work that mainly examined individual newborn care components or maternal postnatal care.Global health impact for policy and action: Strengthening antenatal care, facility-based delivery, postnatal care quality, and targeted support for small and disadvantaged newborns can help improve newborn survival and reduce inequities in fragile health systems.